Fast Health Interoperability Resource Burns Brightly

Fast Health Interoperability Resource Burns Brightly

FHIR is a set of APIs that will work with pretty much any technology. Mobile will be part of that equation.

Early adopters of HL7’s Fast Health Interoperability Resource (FHIR) draft standard are forging ahead with projects designed to deliver real value to healthcare organizations, EHR vendors and patients. As more examples surface across the industry, it’s becoming evident that obstacles to forward progress — although very real — may be no match for innovation.

“We are enabling third-party developers to expand the capabilities of the EHR in a plug-and-play fashion,” explained Raju Gupta, director of technology for Medullan, a digital healthcare consultancy. His framing remarks came during a webcast presentation this week titled “The Innovation Doctor is In: SMART on FHIR” (with SMART referring to the Substitutable Medical Apps & Reusable Technologies platform, a collaborative project led by technology experts at Boston Children’s Hospital and Harvard Medical School).

FHIR defines how to read and write data to an EHR in a standard way, while SMART defines how to pass along the context of patient data. SMART also defines the concept of an app store, where apps can be discovered and made an integral part of a provider’s workflow, Gupta added.

Juliette Ehlert, senior manager of technology at Medullan, demonstrated Prescription IQ, a SMART on FHIR application designed to help patients save money on their medications given two pieces of information: drug name and insurance plan. The app presents options for drug cost based on generic substitution, use of mail-order pharmacies or even pill-splitting. The data manipulation occurs within the context of the EHR system and the patient’s specific record.

Other examples of using SMART on FHIR apps to extend the feature set of an EHR include the following:

Through the Argonaut Project, the five largest EHR vendors — Epic, Cerner, athenahealth, MEDITECH and McKesson — are building SMART into releases of their products.

Duke Medicine is implementing apps on top of its Epic EHR system. Separately, a hackathon held at Brigham and Women’s Hospital in early November featured a track dedicated to creating apps based on Epic’s FHIR application programming interfaces (APIs); teams tackled topics like medication aggregation and surfacing critical lab values.

Mosaic Life Care is testing an app within Cerner’s Millenium EHR that helps clinicians recognize and diagnose visually presenting conditions. It’s available in ambulatory clinics, emergency departments and other areas of the hospital.

HCA, the largest hospital system in the U.S., has partnered with TrialReach to help physicians match patients to clinical trials in HCA cancer centers.

Geisinger Health System has spun out a new business, xG Health Solutions, which offers an app for rheumatology. xG plans other apps for cardiology, oncology and physician documentation.

Outside of the hospital environment, a patient-focused app developed by Infor and Hackensack University Medical Center enables patients to send information to providers before an appointment.

At the same time, however, a number of open issues surrounding FHIR remain to be resolved. For example, Ehlert noted, Stage 3 of the federal EHR meaningful use program requires the use of APIs, but does not explicitly designate FHIR as the basis. “The mandate really is aimed at getting patients access to their data from their EHR, not on interoperability or extension of the EHR,” she commented.

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